ArticlesInterventions to prevent and reduce physician burnout: a systematic review and meta-analysis
Introduction
Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment,1 has reached epidemic levels, with prevalences near or exceeding 50%, as documented in national studies of both physicians in training2, 3 and practising physicians.4, 5, 6 Consequences are negative effects on patient care,7, 8, 9 professionalism,10, 11 physicians’ own care and safety (including diverse issues such as mental health concerns and motor vehicle crashes),12, 13 and the viability of health-care systems, including reductions in physicians’ professional work effort.14, 15 Evidence has linked 1 point changes in burnout scores with meaningful differences in self-perceived major medical errors,8, 9 reductions in work hours,15 and suicidal ideation.12 These concerns have prompted calls for increased attention to physician wellbeing, including efforts targeting burnout.16, 17, 18 Both individual-focused and structural or organisational solutions are required.16 A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary to understand the best evidence for effective interventions and to establish a strong foundation for further research to fill gaps in this literature.
Previous reviews of physician distress have been limited in their ability to inform these issues by a combination of factors, such as an absence of focus on physicians and burnout and inconsistent adherence to modern methodological systematic review standards.19, 20, 21, 22 Therefore, we did a systematic review and meta-analysis adhering to methodological standards to examine the literature to date on interventions to prevent and reduce physician burnout.
Section snippets
Search strategy and selection criteria
In this systematic review and meta-analysis (reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement23), we did a literature search to identify studies of interventions to prevent and reduce physician burnout, with the aid of an experienced medical librarian (PJE). We included studies collecting comparative data to assess the effect of an intervention on physician burnout, excluding studies of medical students and non-physician health-care
Results
Our search strategy identified 2617 articles, of which 230 met the criteria for full-text review (figure 1). The characteristics of the included studies are summarised in the appendix. 15 randomised controlled trials including 716 physicians27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 37 unique cohort studies including 2914 physicians42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78
Discussion
Most studies in this systematic review and meta-analysis reported on changes in burnout domain scores, finding a significant reduction in emotional exhaustion and depersonalisation scores. Fewer studies reported on changes in overall burnout or high burnout levels in each domain than on changes in burnout domain scores, finding a significant reduction in absolute burnout and in a high degree of emotional exhaustion and depersonalisation. These effects were consistent between randomised
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